IHSTeCA MEMBERSHIP FORM               

District:                                                                   For the Year:    * One Calendar Year (Jan-Jan)

Last Name:                    Home Phone:     

First Name:                  Home Fax:          

                                                                                                                Home E-Mail:     

Home Address:                 

Home City:          

Home Zip:                           

Are you a Teacher? Yes or No:       If No, what is your occupation 

Name of Business you are employed at or own:     

Work Address:      Work Phone:     

High School Coaching At:    School Phone:

School Address:                 

School City:           School Zip:  

School E-Mail:                                 School Fax:    

If you are a Teacher, is it in the school you are coaching? Yes or No:      

If No, what school do you teach in: 

School Address:   School Phone:  

Coach of Boys? Yes or No:    Head Coach? Yes or No:    Asst Coach? Yes or No:   

                                                                          Years Coaching Boys:      Record Coaching Boys:   

                                                                          Coach Boy's From: To:  

 

 

Coach of Girls?  Yes or No:    Head Coach? Yes or No:     Asst Coach? Yes or No:   

                                                                           Years Coaching Girls:         Record Coaching Girls:   

                                                                           Coach Girl's From: To:  

WINS:          Boys 100 Wins- Year:                             Girls 100 Wins- Year:    

                          Boys 200 Wins- Year:                             Girls 200 Wins- Year:    

                          Boys 300 Wins- Year:                             Girls 300 Wins- Year:    

COACH OF YEAR:          Boys District- Year:                             Girls District- Year:    

                                                           Boys State- Year:                                  Girls State- Year:    

Please complete the above information and send along with your check for $30.00 made out to IHSTeCA to: Don Wafer, IHSTeCA Secretary-Treasurer, 3208 E. Randal Drive, Muncie, IN 47303.